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   Table of Contents - Current issue
July-September 2022
Volume 30 | Issue 3
Page Nos. 59-89

Online since Friday, June 24, 2022

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Free gracilis muscle flap: Variations of obturator nerve p. 59
Yavuz Tuluy, Zulfukar Ulas Bali, Merve Ozkaya Unsal, Aziz Parspanci, Levent Yoleri, Yavuz Kececi
Background: Gracilis muscle has been used in reconstructive surgery for free muscle flap transfer. It was reported to be a reliable flap with lower rates of donor-site morbidity. In this study, we aimed to emphasize the anatomical variations of the obturator nerve. Materials and Methods: Clinical results of 14 patients who underwent lower lip reconstruction and facial reanimation with free gracilis muscle transfer between March 2017 and May 2021 were examined. Results: We identified eight male and six female patients, with a mean age of 55.6 years (range: 37–73 years). Of 14 patients, nine (64.3%) were operated on for lower lip reconstruction, and the remaining five cases underwent facial reanimation. Despite adequate dissection, we could not find the branch of the obturator nerve for gracilis muscle in two cases (14.3%), while vascular pedicles are detected in all cases. The first case was a lower lip reconstruction and the second case was a facial reanimation. Conclusion: While gracilis muscle is a good option for functional muscle transfer, it may be difficult to find the branch of the obturator nerve. Our study may suggest the need for consideration of anatomical variations of the obturator nerve before surgical planning for improved shared decision-making.
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Evaluation of hand injuries admitted to emergency department of a tertiary care center: Analysis of 10352 patients p. 63
Mehmet Besir Oner, Can Ege Yalcin, Semih Baghaki, Anil Demiroz, Ibrahim Ikizceli, Oguz Cetinkale
Background: In this study, we aimed to evaluate the characteristics of patients who were admitted to the emergency department for a hand injury and to make preventive inferences for hand injuries in terms of public health. Materials and Methods: We conducted a retrospective analysis of 10,352 patients admitted to the emergency department between August 2016 and July 2020. Results: The average age was 28.4. Injuries mostly occurred in the 25–34 age interval (18.7%). Men predominated in the patient group (70.27%), and injuries were almost equally distributed between right and left sides, with fingers being the most frequently affected region. Common etiologies included falling, occupational injury, and home accidents, leading most frequently to fracture/dislocations, skin-nail injuries, and tendon injuries. Amputations comprised 6.3% of the injuries. Complicated injuries mostly occurred in young males and were mostly due to work accidents. Conclusions: Hand injuries can be devastating, and increased individual and social awareness and improved occupational standards are required for prevention (level of evidence: III).
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Feasibility of microsurgery in burn injury and the effect of stem cell application p. 69
Ersin Gur, Yigit Ozer Tiftikcioglu, Gulinnaz Ercan, Hafize Seda Vatansever, Yakup Isik, Hilal Kabadayi, Ayfer Karlitepe, Ecmel Songur
Introduction: Burn is one of the most severe traumas and can affect skin, muscle, or bone. Although early debridement and use of skin grafts have proven their benefits; in some cases, free flaps are required for early reconstruction. It is undisputed that choosing recipient vessels from unburned or undamaged zones increase the success of anastomosis. However, it may not be possible, especially in large burns. Our study aims to investigate the success of anastomosis beneath burned tissues and the effects of stem cell application. Materials and Methods: Twenty-one Wistar albino male rats weighing 250 g on average were divided equally into three Groups. In Group I, femoral artery anastomoses were done as control group. Inguinal area of 7 rats was burned as deep 2nd degree depth, and femoral artery anastomoses were done immediately beneath the burned tissues. In Group III, after burning inguinal area and making anastomoses, adipogenic stem cells were applied on the anastomosis sites. All anastomoses were checked at postoperative 3rd day. Results: One rat of Group I died in the postoperative 3rd day and one rat of Group II had a wide wound dehiscence including many of foreign body on anastomosis zone so both were excluded from the study. One anastomosis in Groups I and 3 anastomoses in both Groups II and III failed and others were successful. Statistical analyzes showed that there was no difference between groups (P < 0.05). Stem cell application was not effective on anastomosis patency in burn injury but has benefits in wound healing according to our study. Conclusion: Recipient vessels can be chosen from adjacent area to burn or inflammation zone safely for microvascular anastomosis if there is no direct burn damage on vessels.
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Etiology of a rare intraglandular foreign body in the parotid gland: Vegetable nidus p. 76
Cem Oz, Emin Kapi, Sanem Oksan Erkan, Ozgur Kulahci
Foreign bodies observed in the parotid gland generally origins from trauma. These foreign bodies are commonly solid structures such as metal, stone, and glass, but foreign body compatible with plant histomorphology is a rare condition. In this study, we present the diagnosis and treatment methods that we applied to this clinical entity, which is very rare in the literature. A 44-year-old female patient who applied to our clinic with a mass on her left cheek that developed in the past 3 months was evaluated. The patient underwent foreign body excision from the parotid gland. On the patient who had a stricture in the Stensen duct during intraoperative exploration, the duct was dilated, and the patient was followed up. Foreign body with vegetative morphology, which settles into the parotid gland by retrograde migration, is a very rare condition. The importance of being aware of possible complications, and a meticulous surgical approach should also be taken into consideration.
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A severe electrothermal ring burn case and a proposed treatment algorithm p. 79
Burak Ozkan, Abbas Albayati, Suleyman Savran, Cagri Ahmet Uysal
Ring-associated burns are infrequent comprising only a tiny fraction of burn consults. Due to the circular nature of rings, these burns are often circumferential, with an increased risk for compartment syndrome and neurovascular injury. The severity of ring burn is related to the type of material and electrical current. Low-voltage injuries are generally due to contact with batteries and household devices, while high-voltage electric injuries occur with occupation-related accidents or natural disasters. Low-voltage ring burn can be managed conservatively with close follow-up. However, high-voltage ring burn might have dramatic consequences such as finger amputation. To date, there have been few cases reported in the literature of a ring burn. Most cases were superficial burns and managed with secondary healing or skin grafting. However, the literature has not reported the management of a severe ring burn with deteriorated finger circulation. In this case report, we present a circumferential electrothermal ring burn case with resulted in total loss of a finger. Furthermore, we propose an algorithmic approach to ring burn injuries.
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Rhinoplasty on patients with von Willebrand's disease: Tranexamic acid may be a better choice than desmopressin in selected cases p. 82
Galip Gencay Ustun, Zuhre Kaya
Von Willebrand's disease (VWD) is the most common hereditary bleeding disorder. Due to its frequency, occasionally, patients with this disease apply for rhinoplasty. Classically, desmopressin is used in emergent cases, and it is highly effective. However, the lack of long-term treatment and possible side effects limit the desmopressin treatment. Because the fibrinolytic activity in the nasal mucosa is high, antifibrinolytics such as tranexamic acid are beneficial in all types of VWD. An 18-year-old patient with Type 1 VWD who was operated without facing any complications is presented. Treatment involved 4 days of treatment starting the day before the surgery and healing process was uneventful. Patients with a diagnosis of VWD can be operated successfully with preoperative tranexamic acid treatment and using vasoconstrictor agents and avascular surgery planes. In Type 1 VWD or low von Willebrand's factor cases, tranexamic acid is a safe and successful treatment alternative due to its long-term use, local and systemic applicability, and regional affinity.
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A rare cause of facial asymmetry: Recurrent hemifacıal lipomatosis p. 85
Yasin Celal Gunes, Deniz Sozmen Ciliz, Huseyin Cetin
The hemifacial lipomatosis (HL) is an extremely rare pathology that results in partial hemifacial hypertrophy. This case report presents a 16-year-old male patient who underwent surgery for swelling in the right hemifacial region 11 years ago and then presented to our hospital with a diagnosis of recurrent HL in the same area.
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Social media behavior in plastic surgery practice: Correspondence p. 88
Pathum Sookaromdee, Viroj Wiwanitkit
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Introductory letter for the HandMicro 2022 congress p. 89
Bulent Sacak, Omer Berkoz
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